Endovascular mechanical thrombectomy is an important progress in the treatment of acute ischemic stroke,and early and timely endovascular mechanical thrombectomy can provide significant clinical benefits.The treatment mode of endovascular therapy after intravenous thrombolysis is bridging therapy,while the traditional bridging therapy may have limitations such as time delay and increased bleeding risk.In recent years,with the completion of several large scale randomized controlled trial,whether to bypass intravenous thrombolysis and directly perform mechanical thrombectomy has become a hot topic in the field of stroke treatment.In addition,the third generation of thrombolytic drug Tenecteplase has a more convenient way of administration,it also provides new ideas for bridging therapy.This article compares and analyzes the benefits and risks of direct mechanical thrombectomy therapy and bridging therapy based on relevant research that has been completed,aiming to provide reference for the correct selection of treatment methods for acute ischemic stroke patients.

ObjectiveTo investigate the clinical features of patients with acute-on-chronic liver failure （ACLF） and bacterial infection and early warning indicators associated with multidrug-resistant infections. MethodsA retrospective analysis was performed for 130 patients with ACLF and bacterial infection who attended The Second Affiliated Hospital of Air Force Medical University from January 1， 2010 to December 31， 2021， and according to the drug susceptibility results， the patients were divided into multidrug-resistant （MDR） bacterial infection group with 80 patients and non-MDR bacterial infection group with 50 patients. General information and laboratory examination results were compared between the two groups to screen for the early warning indicators associated with MDR bacterial infection. The Student’s t-test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The binary logistic regression analysis and the receiver operating characteristic （ROC） curve were used to assess the predictive value of early warning indicators. ResultsAmong the 130 patients with ACLF and bacterial infection， sputum （27.7%） was the most common specimen for detection， followed by blood （24.6%）， urine （18.5%）， and ascites （17.7%）. Bacterial infections were dominated by Gram-negative bacteria （58.5%）. Of all bacteria， Escherichia coli （18.5%）， Klebsiella pneumoniae （14.6%）， and Enterococcus faecium （13.8%） were the most common pathogens. Gram-positive bacteria had a high resistance rate to the antibacterial drugs such as erythromycin （72.2%）， penicillin （57.4%）， ampicillin （55.6%）， and ciprofloxacin （53.7%）， while Gram-negative bacteria had a high resistance rate to the antibacterial drugs such as ampicillin （73.3%）， cefazolin （50.0%）， and cefepime （47.4%）. The patients with ACLF and bacterial infection had a relatively high rate of MDR bacterial infection （61.5%）. Comparison of clinical data between the two groups showed that compared with the patients with non-MDR bacterial infection， the patients with MDR bacterial infection had significantly higher levels of alanine aminotransferase （Z=2.089， P=0.037）， aspartate aminotransferase （Z=2.063， P=0.039）， white blood cell count （Z=2.207， P=0.027）， and monocyte count （Z=4.413， P<0.001）. The binary logistic regression analysis showed that monocyte count was an independent risk factor for MDR bacterial infection （odds ratio=7.120， 95% confidence interval ［CI］： 2.478‍ ‍—‍ ‍20.456，P<0.001） and had an area under the ROC curve of 0.686 （95%CI： 0.597‍ ‍—‍ ‍0.776） in predicting ACLF with MDR bacterial infection（P<0.001）， with the optimal cut-off value of 0.50×10⁹/L， a sensitivity of 0.725， and a specificity of 0.400. ConclusionACLF combined with bacterial infections is mainly caused by Gram-negative bacteria， with the common pathogens of Escherichia coli and Klebsiella pneumoniae and a relatively high MDR rate in clinical practice. An increase in monocyte count can be used as an early warning indicator to distinguish MDR bacterial infection from non-MDR bacterial infection.

Objective: To assess the current evidence regarding the efficacy, safety, and potential advantages of endoscopic compared with open salvage surgery for patients with local recurrent nasopharyngeal carcinoma. Methods: A systematic search of Pubmed/Medline, Embase, and Cochrane databases ranged between 2000 and 2017 was conducted. Included studies reported specific residual or local recurrent nasopharyngeal cancer survival data. Proportional Meta-analysis was performed on both outcomes with a random-effects model and the 95% confidential intervals were calculated by Stata 12.0 software. Results: A total of 24 case series studies were included in the Meta-analysis.The pooled 2-year overall survival rates of endoscopic and open group were 84% (95%CI:72%-93%), 68%(95%CI:59%-77%),respectively.The pooled 2-year disease-free survival rates of endoscopic and open group were 68%(95%CI:53%-81%), 65%(95%CI:54%-75%),respectively. The pooled 5-year overall survival rates of endoscopic and open group were 72%(95%CI:37%-97%), 48% (95%CI:40%-56%),respectively.The pooled 5-year disease-free survival rates of endoscopic and open group were 65%(95%CI:29%-93%), 50%(95%CI:43%-57%),respectively.The combined outcome of endoscopic was higher than open procedure. In addition, less severe complications, lower local recurrence rates(27%vs32%).The 2-year overall survival rates of endoscopic was higher than open procedure in the staging of rT1, rT2, and rT3 (93%vs87%; 77%vs63%; 67%vs53%) , but was equal to open in the staging for rT4 (35%vs35%) .Meta-regression showed that the heterogeneity was correlated with advanced tumor ratio. Conclusions The present Meta-analysis reveals that endoscopic approach offers a safe and efficient alternative to open approach with better short-term outcome and fewer postoperative complications in selecting patients strictly.

Through analyzing the existing problems in the current mode, the vital signs monitoring information system based on cloud platform is designed and developed. The system's aim is to assist nurse carry out vital signs nursing work effectively and accurately. The system collects, uploads and analyzes patient's vital signs data by PDA which connecting medical inspection equipments. Clinical application proved that the system can effectively improve the quality and efficiency of medical care and may reduce medical expenses. It is alse an important practice result to build a medical cloud platform.
Cloud Computing ; Humans ; Monitoring, Physiologic ; instrumentation ; Vital Signs

Objective To explore the tutorial system of biomedical engineering students in medical colleges and universities,and provide useful references for the implementation of undergraduate tutorial system in medical colleges and universities in China.Methods Based on the compulsory professional knowledge and skills of biomedical engineering students,the undergraduate tutorial system of biomedical engineering specialty was analyzed and summarized with thatof School of Biomedical Engineering of the Fourth Military Medical University taken as an example.Results The necessity,problems and new mode were pointed out for the undergraduate tutorial system of biomedical engineering specialty.Conclusion The implementation of undergraduate tutorial system is a new idea of deepening the reform of undergraduate education in biomedical engineering specialty,and is of important significance to improve the professional skills of students.

Objective:To evaluate the effects of the flowable resin used as pit and fissure sealant using different etching adhesive systems.Methods:60 caries-free extracted human premolars were randomly divided into 4 groups(n =1 5)and treated by Gluma, NT and 3M-Z350 flowable resin(group A);Clearifil SE Bond adhesive and 3M-Z350 flowable resin(group B),phosphoric acid etching,3M-Z350 flowable resin and phosphoric acid etching(group C)and 3Mconcise sealant(group D)respectively.After pro-cessing the tooth surface the pit and fissue of 1 0 sample in each group were sealed.The microleakage was measured by 1 % methyl-ene blue staining(n =8).The material-enamel interface was observed by SEM(n =2).The shear bond strength of the column-shaped samples with the diameter and the height of 3 mm(n =5)on the mesial or dental surface was examined by a test machine. The sealant cartridges and flowable resin cartridges with the diameter and height of 4 mm were used for the crushing strength exami-nation(n =1 0).Results:There was no significant difference in the microleakage among the 4 groups.SEMobservation showed that the resin tags of group A were long and dense and the resin tags of group B were short and sparse,bubbles and cracks were found on the local site in group A and B.The resin tags of group C were long and thin,but combined with tooth tightly;the resin tags of group D were short and dense;the penetration was poor at the bottom of the fissures in the 4 groups.The shear bond strength of Group A was the highest(P <0.01 ),that of group C was higher than that of group B and D(P <0.05).There was no significantly difference between group B and D(P >0.05).The compressive strength of flowable resin groups was higher than that of fissure seal-ant group(P <0.05).Conclusion:The shear bond strength and compressive strength of all-etching bonding system combined with flowable resin is superior to that of self-etching bonding system combined with flowable resin and the traditional sealant.Using Prime&Bond NT bond after acid etching may improve the shear bonding strength.

Compounds with serotonin reuptake inhibition/5-HT(1A) dual activity were used to build 3D pharmacophore model as a training molecules by Discover Studio. Based on the model, 8 novel aryl piperazine benzo[b][1,4] oxazine derivatives were designed and synthesized, and their structures were confirmed by 1H NMR and HR-MS. Biological evaluation illustrated that compounds VI(1) and VI(7) showed potent functional activities at both 5-HT transporter and 5-HT(1A) receptor, which can be used as lead compounds to guide future research of design and synthesis of potent novel compounds.

OBJECTIVETo assess the effects of tumor necrosis factor-α (TNF-α) in enhancing the radiosensitivity of lung cancer cells in vitro.

METHODSA549 cells were exposed to γ-ray with or without TNF-α treatment. MTT assay was used to evaluate the cell viability, and flow cytometry was performed to assess the cell apoptosis. Western blotting was used to observe the expression of caspase-3 protein in the exposed cells.

RESULTSCompared with the exposed cells without TNF-α treatment, the cells treated with TNF-α showed significantly suppressed cell proliferation, increased the cell apoptosis, altered cell cycle, and increased caspase-3 protein expression after γ-ray exposure.

CONCLUSIONTNF-α can enhance the radiosensitivity of A549 cells to increase the efficiency of radiotherapy with γ-ray irradiation.

Apoptosis ; drug effects ; radiation effects ; Cell Cycle ; drug effects ; radiation effects ; Cell Line, Tumor ; Gamma Rays ; Humans ; Lung Neoplasms ; Radiation Tolerance ; drug effects ; Tumor Necrosis Factor-alpha ; pharmacology

Objective This study was designed to determine the in vitro sensitivity of LMWH caused by different reagents,and to explore whether the ACT can be used to monitor LMWH.Methods This study was performed in vitro.ACT was measured with different reagents(glass beads,celite,and kaolin)on volunteer(n =30)blood samples spiked with increasing concentrations of LMWH(datleparin,0.2-1.8IU/ml).Linear regression analysis was performed to establish a regression equation from different concentration of datleparin and corresponding ACT values.Results Analysis of dose-response curves obtained in vitro,an excellent linear relationship was observed between the ACT and dalteparin concentrations for all three reagents(p less than 0.01).Differences in slope of the regression curves of ACT were observed with all the reagents tested(glass beads 249.7s/IU,celite 77.7s/IU,and kaolin 59.3s/IU,p less than 0.01).Reagents vary widely in their in-vitro sensitivity related to dalteparin.In the concentration range of 0.2-1.8 IU/ml,the gaolin reagent was insensitive to dalteparin,and glass beads was the most suitable reagent for monitoring the anticoagulant effect of dalteparin.Conclusions Glass beads,celite,and kaolin.Glass beads were the most suitable reagent for monitoring the anticoagulant effect of dalteparin.Vary widely in their in-vitro sensitivity related to datleparin.